Posted by europerep on January 17, 2015, at 15:15:08
In reply to Re: Splitting pills. Reliable or not? (@Ed and others), posted by ed_uk2010 on January 17, 2015, at 13:52:35
Hi Ed :)...
To answer your last question first, yes, your reply helps me a lot. I'll just address a few things you said:
> There's a very large variability in the blood levels of tricyclic antidepressants in patients given the same dose, probably due to genetic differences in hepatic metabolism. It makes sense that dosage requirements for these drugs are very variable.
Hmm, I did not know this yet, but this could indeed be an explanation. What happened was that I'd add 25mg of amitriptyline (i.e. one capsule) to my daily dose, and I'd feel better for a day or two, but the improvement then disappeared. Then I'd take the capsule away again, and now too I'd briefly feel better. So I thought, maybe the right dose for my is somewhere in between, and that's how I came to prepare my individual doses. And it really works pretty well. I'm sure at least some patients out there would benefit from an availability of a wider dose range for these drugs...
> Some nortriptyline tablets have a thin 'film' coating. Do yours not? You've not mentioned any ingredients used to coat tablets above. Have you listed all the tablet ingredients? If you have, your tablets are not coated.
Yeah, I was wondering that too. I found the same quote from the internet that I posted yesterday in the package insert, with no further information. The word "include" suggests to me that there may be other ingredients in it, but they're not specified. It happens to be a UK product, so if you want I can tell you the manufacturer's name, and you could verify that. Only if you want of course.
But I was precisely wondering whether the pills have a coating that does not contain any active ingredient. Visually there is none, both from what the tablet looks like (compared to others I had that were coated), and if you cut the tablet and then look at the inside, there are no separate layers. But there could well be two layers that just happen to have the same colour.
> Breaking fragments off uncoated tablets may produce more accurate dosages (compared with coated tablets) because the drug is evenly distributed throughout the entire tablet.
This sounds good!
> It's hardly important for the dose of nortriptyline to be consistent to the microgram level!
I had been wondering about that as well. Do you happen to know how big the allowed variations of active ingredients in pharmaceutical products are? I wouldn't be surprised if even "real" (i.e. non-manipulated) tablets would show some variation in the microgram level that are not noticeable by the patient.
> If you do break fragments off the tablets it's best to dispose of the unused portion. Keeping lots of 'bits' may be a bad idea because they could absorb moisture from the air and degrade over time.
Thanks, this advice seems reasonable as well.
> Does this answer your Q?So, yes, this is all very helpful, thanks a lot!
ER
poster:europerep
thread:1075154
URL: http://www.dr-bob.org/babble/20150102/msgs/1075195.html